A Turkish clinic swaps refugees' warzone-welded prosthetics for free 3D-printed ones

They lost their limbs to wars in Syria, Yemen, Afghanistan, and elsewhere. The enemy was the same: military missiles, rebel rockets, insurgent IEDs.

Some of those with amputated limbs turned to metalsmiths, who welded together basic prostheses, sometimes using corroded iron boots – so that the victim could at least walk until a better prosthesis could be arranged. Others only managed to lay their hands on donated crutches.

Whether it's Mahmoud Qabbani, a Syrian tailor who was on his way to work when regime warplanes struck with missiles, wounding his leg, which was later amputated, or Mari Muveli of Afghanistan, who lost her leg to a Taliban attack years ago, victims continue to approach this clinic in Istanbul, Turkey, run by an alliance of global doctors, which makes cutting edge prosthetics that help amputees walk again.

Turkey hosts around 3.7 million Syrian refugees, the highest anywhere on the planet, along with around 330,000 refugees from Afghanistan, Iraq, and other regions. And thousands of them are in need of prostheses.

"It leaves us in tears when we see wounded refugees coming to us with medieval-era iron legs prepared by welders there [in conflict areas]," Dr. Yasar Tatar of Alliance of International Doctors (AID) told Interesting Engineering (IE).

In just roughly five years of its orthotic and prosthetic mission, AID clinic, which is funded by Gulf charities including Kuwait's Zakat House and Turkey's Humanitarian Relief Foundation, has provided war victims and disaster-affected people with more than 2000 prosthetic limbs, including 600 prosthetic modifications.

"The difference between Syria's wounded and victims of the rest of the wars is that Syrians have been losing limbs to bombings. Others are mostly hit by landmines or IEDs. Around 80 percent of the victims we receive are from Syria," said Tatar, who has been working as a humanitarian medic for the last 22 years.

The UN estimates that more than 1.5 million Syrians are living with permanent impairments, including 86,000 people who have lost limbs. And this clinic has been a ray of hope for hundreds of poor families who come here for free treatment.

Mahmoud Qabbani, 37, from Syria's Aleppo region, came to the AID clinic with his wife to repair his prosthetics. He was wounded in 2015 during a Syrian regime strike in which he lost his left leg.

"I saw a Facebook advertisement saying 'this AID center helps people.' The doctors here treat me like their own. There isn't anything better than this," he said.

Prosthetic limb prices can range anywhere from $3,000 to $70.000. The factors that determine the cost include the type of amputation and the quality of the prosthetic leg.

The NGO uses cutting-edge, 3D-printed limbs produced at their three-story clinic in Istanbul's Fatih district. This method allows prosthetics to be prepared quickly and accurately for people wounded in wars and other disasters.

This small center has been a ray of hope for hundreds of low-income families who come here for free treatment.

Free 3D-printed limbs, a hope for refugees

Globally, access to up-to-date prosthetic treatment is scarce. More than 75 percent of developing nations lack a prosthetics and orthotics training program.

According to the World Health Organization, just one in ten people in need have access to assistive products, including prostheses and orthoses, because of their high cost and because of lack of awareness, availability, trained personnel, policy, and financing.

The World Health Organization also estimates that 30 million individuals are currently in need of prosthetic and orthotic devices.

However, the ability of engineers and doctors to use 3D printing to create totally personalized prosthetics for the wearer has revolutionized the field. And a more revolutionary development is being sparked by 3D printing that can be created by almost anybody, anywhere.

"In places far away from the centers, such as in disaster-hit countries and war zones, a single technician is able to get the patient's dimensions via 3D scanners and transfers the data to the center without going through the trouble of carrying plaster casts, and cast-equipment, etc.," Büşra, a biomedical engineer working at AID clinic, who wanted to be identified with her first name, told IE.

"The custom-made prostheses and orthoses are made after using 3D scanning technologies which provide digital 3D models for printing," she added.

Mari Muveli, 35, an Afghan refugee living with her children in Istanbul's Eskisehir municipality for the last ten years, is a single parent after she got divorced and lives on a monthly stipend provided by the Turkish state. She is visiting the clinic for the first time to get her new prosthetics made here.

"I lost my leg during a Taliban attack when I was a teenager. I was told by people that it would cost me $10,000 to get the right prosthetics. The UN office for refugees kept delaying my treatment," she said.

"So, I finally landed at this clinic, and they have really helped me get back on my feet with their technology," she said.

An easy experience for the patients

Medical 3D printing includes the creation of custom casts that are composed of lightweight plastic and precisely suit the patient. The production costs of such medical equipment are reduced by the use of additive manufacturing technologies, making them more accessible to the general public.

"After the 3D scanner captures data, it is exported to modeling software. The digital model is readied for modeling in the Rodin4D Neo program, a specialized software used to create orthotics and prostheses," Büşra said.

"In 4-6 hours, the prosthetic socket is printed, which is way better than older methods."

Thermoplastic filament PC-Max (polycarbonate), which is one of the most durable materials among the filaments, is used for printing prosthetic sockets with a 3D printer, Rodin4D-Kühling Kühling, a German technology.

The socket is then readied for printing after 3D modeling is complete, and a printable file is produced using slicing applications (software).

"This 3D technology is an innovation that has made the work of our prosthetic, orthotic technicians much easier. Patients' measurement taking and modeling of the prosthesis has become quite simple," said Temren Mehmet, a prosthetic technician at the AID center.

"Ease of measuring, production speed, and reduced chance of error create a win-win situation for the patient and the technician. I think that the field of prosthetic orthotics will develop in the light of 3D printer technology, as in most areas."

The 3D technology used for prosthetics has allowed researchers and scientists to gather data from complex models which is not possible to measure through traditional devices.

And, instead of having to buy new sets of prosthetics as they grow bigger, parents or doctors can just print larger prosthetic parts making the process an easy experience for the patients.

Meanwhile, Mohammad Raoun, 17, is being helped by a nurse to stand on his legs once again with a new prosthetic leg.

"Five years ago, when I was 12, I was wounded in a rocket attack in Aleppo. I was taken to a local hospital, but it didn't help. Life became very difficult," said Raoun.

"Then I came to Turkey, and this clinic (AID) helped me with my prosthetics. They have made me a new 3D-printed one and a better fit."

AID now operates four centers in three different countries to help limbless patients with prosthetics.